Evidence of Echocardiographic Markers of Pulmonary Vascular Disease in Asymptomatic Infants Born Preterm at One Year of Age

Levy, P. T.; Patel, M. D.; Choudhry, S.; Hamvas, A.; Singh, G. K.

J Pediatr. 2018 Apr 8; 197:48-56.e2

Abstract

OBJECTIVE: To test the hypothesis that echocardiographic markers of pulmonary vascular disease (PVD) exist in asymptomatic infants born preterm at 1-year corrected age. STUDY DESIGN: We conducted a prospective cohort study of 80 infants born preterm (<29 weeks of gestation) and 100 age- and weight-matched infants born at term and compared broad-based conventional and quantitative echocardiographic measures of pulmonary hemodynamics at 1-year corrected age. Pulmonary artery acceleration time (PAAT), a validated index of pulmonary vascular resistance, arterial pressure, and compliance, was used to assess pulmonary hemodynamics. Lower PAAT is indicative of PVD. Subanalyses were performed in infants with bronchopulmonary dysplasia (BPD, n = 48, 59%) and/or late-onset pulmonary hypertension (n = 12, 15%). RESULTS: At 1 year, there were no differences between conventional measures of pulmonary hypertension in the infants born at term and preterm. All infants born preterm had significantly lower values of PAAT than infants born at term (73 +/- 8 milliseconds vs 98 +/- 5 milliseconds, P < .001). Infants born preterm with BPD had even lower PAAT than those without BPD (69 +/- 5 milliseconds vs 79 +/- 4 milliseconds, P < .01). The degree of PVD at 1-year corrected age was inversely related to gestation in all infants born preterm. Data analysis included adjustment for ventricular function and other confounding factors. CONCLUSIONS: In comparison with infants born at term, infants born preterm exhibit abnormal PAAT at 1-year corrected age irrespective of neonatal lung disease status, suggesting the existence of PVD beyond infancy. PAAT measurements offer a reliable, noninvasive tool for screening and longitudinal monitoring of pulmonary hemodynamics in infants.

Lurie Children's provides healthcare regardless race, color, religion (creed), sex, gender identity or expression, sexual orientation, national origin (ancestry), or disability. Financial assistance for medically necessary services is based on family income and hospital resources, and is provided to children under age 21 whose primary residence is in Illinois, Indiana, and Wisconsin.

Lurie Children's complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability.